Durbach Joshua R, Rosen Gerald, De La Cuesta Carolina, Gottlieb Seth
Anesthesiology, Critical Care and Internal Medicine, Mount Sinai Medical Center, Miami, USA.
Anesthesiology, Mount Sinai Medical Center, Miami, USA.
Cureus. 2022 Aug 12;14(8):e27923. doi: 10.7759/cureus.27923. eCollection 2022 Aug.
Neuroleptic malignant syndrome (NMS) has been defined as a life-threatening neurologic emergency related to the use of antipsychotic medications. It is most often seen with high-potency (first-generation) antipsychotic medications and may occur after a single dose. There have been conflicting reports in the literature of an atypical NMS (ANMS) presentation, associated with lower-potency agents (second generation) antipsychotic medications. NMS is usually diagnosed with a tetrad of clinical symptoms although none of the tetrads is needed for diagnosis. We report a case of a patient admitted for severe acute syndrome coronavirus 2 (SARS-CoV2) pneumonia who developed probable ANMS. SARS-CoV2 also referred to as coronavirus disease 2019 (COVID-19) added another dimension of complication to patient care as we have, at this time, an incomplete understanding of the pathogenesis. We feel critical care clinicians should maintain broad differentials to clinical findings, during the use of multiple medications and not simply attribute the various presentations to COVID-19.
神经阻滞剂恶性综合征（NMS）被定义为一种与使用抗精神病药物相关的危及生命的神经急症。它最常出现在高效能（第一代）抗精神病药物使用过程中，且可能在单次用药后发生。文献中关于非典型NMS（ANMS）表现的报道存在矛盾，这种表现与低效能药物（第二代）抗精神病药物有关。NMS通常根据一组四项临床症状进行诊断，不过诊断并不需要所有这四项症状都存在。我们报告了一例因严重急性2019冠状病毒病（SARS-CoV2）肺炎入院的患者，该患者出现了可能的ANMS。SARS-CoV2也被称为冠状病毒病2019（COVID-19），由于我们目前对其发病机制的理解尚不完整，这给患者护理增加了另一层面的复杂性。我们认为重症监护临床医生在使用多种药物期间应对临床发现保持广泛的鉴别诊断，而不应简单地将各种表现都归因于COVID-19。
